Browsing by Author "Ball, Chad Geoffrey G."

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    Acute Care Surgery Outcomes
    (2019-05-15) Al-Busaidi, Omar Mohammed; Kortbeek, John Barry; Ball, Chad Geoffrey G.; Stelfox, Henry Thomas; Austen, Lea; Turin, Tanvir Chowdhury
    Introduction: The acute care surgery (ACS) model was initiated two decades ago to address issues of availability, timeliness and quality in emergency general surgery care. Previous publications were retrospective, single centred and lacked specific information about morbidity and mortality rates of common ACS procedures. Given that ACS is an evolving model and that the full impact of its implementation is not yet fully understood, we studied the effect of ACS implementation on morbidity and mortality. Methods: Part I, a systematic review and meta-analysis of outcome studies of appendectomies and cholecystectomies before and after the implementation of ACS. Part II, a prospective analysis of ACS post-operative morbidities and mortality in 8 high-volume centres (excluding trauma) was performed. The evaluation was conducted over a 30-day period. Results: In part I, of 1704 studies, 27 studies were selected for analysis. Following ACS introduction, the overall complication rate was significantly reduced in both appendectomy and cholecystectomy (Risk ratios = 0.7; 95% CI 0.57 to 0.85 and RR=0.6; 95% CI 0.40 to 0.94) respectively. Length of stay and time to operate were significantly reduced in both groups. In part II, there were a total of 601 post-operative patients who were followed for up to a period of 30 days. Of those, 66% of the procedures were laparoscopic. The overall complication rate was 34% and mortality was 2%. In open procedures, the morbidity rate was 73%. Conclusions: The implementation of the ACS model was associated with a significant reduction in morbidity and mortality in patients’ with appendicitis and cholecystitis. ACS patients continue to represent a high-risk population. Appropriate hospital and system resources are essential for successful implementation of the ACS model. Keywords: Acute care surgery, ACS, appendectomy, cholecystectomy. Morbidity
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    The Role of Procalcitonin Measurements in Predicting Clinical Outcomes in Critically Ill/Injured Patients
    (2019-07-12) Al Rawahi, Aziza; Kirkpatrick, Andrew Wallace; Doig, Christopher James; Ball, Chad Geoffrey G.; Dixon, Elijah G.
    Background: Major trauma is associated with high incidence of septic complications and multiple organ dysfunction (MOD). We assessed the prognostic value of serum and peritoneal procalcitonin (PCT) levels after trauma. Methods: We searched electronic database and included original studies that assessed prognostic value of PCT after trauma. We performed a retrospective analysis of the Intraperitoneal Vacuum Trial to assess correlation of plasma and peritoneal levels of PCT with clinical outcomes in patients managed with the open abdomen (OA) technique. Results: Among 2,015 citations identified, 19 studies met inclusion criteria. All studies showed a strong correlation between initial PCT levels and Injury Severity Score (ISS). Initial peak PCT levels predicted development of sepsis and MOD after trauma. Conclusion: PCT seems to hold promise as a surrogate biomarker for trauma. Initial peak PCT level may be used as an early predictor of sepsis, MOD, and mortality in trauma population.